年會筆記｜2022 年 TSOC/THS 針對有高血壓的中風患者的建議指南 （尚未公佈)
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急性缺血性腦中風 (Acute ischemic stroke, AIS)
1. It is not recommended for BP lowering in the prehospital setting without knowing the phenotypes of stroke. (COR: Class III; LOE: Ｂ)
在不了解中風類型的情況下，不建議在院前環境下降低血壓
2. Routine aggressive BP lowering is not recommended unless BP >220/120 or in the presence of other situations needing immediate BP lowering (such as acute aortic dissection, congestive heart failure with lung edema, hypertensive encephalopathy) within 24 hours of AIS without undergoing IVT or EVT. (COR: Class III; LOE: A)
在沒有要進行 IVT 或 EVT 的情況下，不推薦常規的積極降壓，除非血壓大於 220/120 mmHg ，或者在急性缺血性中風 24 小時內有其他需要立即降壓的情況（如急性主動脈剝離、鬱血性心臟衰竭伴肺水腫、高血壓性腦病變）
3. BP should be controlled to <185/110 mmHg before starting IVT or EVT for AIS. (COR: Class I; LOE: C )
在開始 IVT 或 EVT 治療急性缺血性中風前，血壓應控制在小於 185/110 mmHg。
4. BP should be controlled to <180/105 mmHg within 24h after IVT or EVT for AIS. (COR: Class Ila; LOE: Ｂ )
在 IVT 或 EVT 治療急性缺血性腦中風後 24 小時內，血壓應控制在小於 180/105 mmHg。
5. Before successful recanalization, avoidance of a large BP reduction (>40%) during EVT should be considered (COR: Class Ila; LOE: Ｂ) and strict SBP control around 140-180 mmHg may be considered. (COR: Class lib; LOE: C)
在成功恢復灌流之前，應考慮避免在 EVT 期間大幅降壓（定義：大於 40%）── 可考慮嚴格控制收縮壓在 140 到 180 mmHg 左右。 (COR: Class lib; LOE: C)
6. Keeping lower BP to <140/90 may be considered within 24 hours after successful EVT for AIS. (COR: Class IIb; LOE: C)
在急性缺血性腦中風的 EVT 成功後 24 小時內可考慮將血壓保持在小於 140/90 毫米汞柱
1. BP-lowering treatment is recommended if SBP exceeds 220 mmHg in patients with acute phase of ICH. (COR: Class I; LOE: C) 如果 ICH 急性期患者收縮壓超過 220 mmHg，建議進行降壓治療
2. In patients with acute hemorrhagic stroke within 6 hours and SBP around 140-180 mmHg, SBP deduced by 20-60 mmHg within 1 hour and maintained <140 mmHg for 1-24 h should be considered. (COR: Class Ila; LOE: A)
針對 6 小時內的急性出血性腦中風患者，若其收縮壓在 140 至 180 mmHg，應考慮在 1 小時內將 收縮壓下降 20 到 60mmHg 並維持小於 140mmHg 1 到 24小時。
3. Anti-hypertensive treatment should be performed if SBP exceeds 160 mmHg for more than 30 minutes in patients with acute aneurysmal SAH and BP target around 120-160 mmHg should be considered until the treatment of aneurysm (COR: Class Ila; LOE: C) 如果急性動脈瘤性硬腦膜下出血患者的收縮壓超過 160mmHg 超過 30 分鐘，應進行降壓治療直到啟動血管瘤治療之前，目標應考慮在 120-160 mmHg 左右
4. Personalized BP targets may be considered based on measuring the surrogate of the cerebral blood flow and continuous monitoring intracranial pressure. (COR: Class lIb; LOE: C)
可根據測量腦血流和連續監測顱內壓的監測考慮個體化的血壓目標。
5. Starting anti-hypertensive treatment in patients with acute and stable stroke (no observed deteriorated neurological deficits owing to brain hypoperfusion) within 24-72 hours is reasonable. (COR: Class Ila; LOE: Ｂ )
在 24 至 72 小時內開始對急性期但已穩定（定義：沒有因腦灌流不足而導致的神經功能障礙惡化）的中風患者進行抗高血壓治療是合理的。
6. The initial BP target is < 140/90 mmHg in the convalescence stage regardless of extracranial/intracranial large vessel disease or cerebral small vessel disease (COR: Class I; LOE: Ｂ) and a BP target <130/80 mmHg should be considered for most patients in the chronic stage for secondary prevention of stroke (COR: Class Ila; LOE: A).
無論是顱外、顱內大血管疾病或腦小血管疾病，中風恢復期的初始血壓目標為小於 140/90 mmHg；而對於慢性階段的大多數患者，應考慮血壓目標為小於 130/80 mmHg，以進行中風次級預防
7. A careful observation of brain hypoperfusion-related side effects caused by BP lowering therapy may be considered in patients with bilateral internal carotid artery significant stenosis or basilar artery stenosis (>70% luminal diameter stenosis). (COR: Class lib; LOE: Ｂ )
對於雙側頸內動脈明顯狹窄或基底動脈狹窄（管徑狹窄大於 70%）的患者，可考慮小心地觀察降壓治療引起的腦灌流不足的相關副作用。
8. An ACEI, ARB, diuretic, or calcium channel blockade should be the first-line drug class for secondary prevention of stroke・(COR: Class Ila; LOE: Ｂ )
ACEI、ARB、利尿劑或鈣離子通道阻斷劑應作為腦中風二級預防的一線藥物種類・
